1720957673 NPI number — MS. AMANDA L MARSTON RN, BSN, MSHA

Table of content: MS. AMANDA L MARSTON RN, BSN, MSHA (NPI 1720957673)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720957673 NPI number — MS. AMANDA L MARSTON RN, BSN, MSHA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARSTON
Provider First Name:
AMANDA
Provider Middle Name:
L
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RN, BSN, MSHA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARSTON
Provider Other First Name:
AMY
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN, BSN, MSHA
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1720957673
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/30/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
60 OLD MONTEREY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OWENTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40359-9030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-484-3412
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 PROGRESS WAY STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OWENTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40359-6032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-484-5736
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/30/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WC1500X , with the licence number:  1103613 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com